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Pre-Visit Forms & Questionnaires - Family and Adolecent

Dear Family,

Welcome to our clinic. We would like to share some information about how to help you get the most benefit in the Department of Child and Adolescent Psychiatry at Redwood City.

The first step in our process is to provide an evaluation for each child, adolescent and family’s needs. We are a multidisciplinary team, and your assessment may include meeting with a clinical psychologist, clinical social worker, marriage and family therapist, or a psychiatrist. Most families begin their contact with us by attending a parent orientation group, which includes an individual meeting with a therapist.

Treatment in our clinic may include individual treatment, family treatment, group treatment, parenting guidance, medication, case management and resource support.

Please provide the following information before the first appointment:

  • The Child, Adolescent, and Parent intake forms. Parents or legal guardians always should always complete the parent form, and teens should always complete the adolescent forms. You can download these forms using the link on the left (Pre-Visit Forms & Questionnaires) and bring completed forms to clinic, or you can come 45 minutes early, get the forms from our reception staff, and fill them out before your appointment.

Adolescent Questionnaire (12 & above)
Child, Adolescent, and Family Data
Child, Adolescent, and Family Data - en Español

  • Records of previous mental health treatment outside of Kaiser, and/or signed Release of Information forms, so that we have permission to communicate with your previous practitioners. You can download these forms from links at the left, or get them from our receptionists when you come in. Ask your non-Kaiser practitioners to call us with relevant information before the first visit, if possible.

Health Information Disclosure
Confidentiality Disclosure
Confidentiality Disclosure - en Español

  • Reports of previous psychological, developmental or educational testing.
  • School records (IEPs, student study team meetings, report cards) which might be helpful.
  • Medical records of care outside of Kaiser, if relevant. Having these records is often essential to our evaluation, and to planning the best care for your child.
  • Legal guardians must bring in legal documents stating they can consent for care.

Who should come to the first appointment?

  • For a child under 12: Parents and/or legal guardians only.
  • For a child 12 and older: Parents and /or legal guardians must come, and your child or teen may come as well.
  • For children of any age with moderate to severe developmental delays: Parents and/or legal guardians only.

Appointments with a psychiatrist: Parent/guardian consent is required for all medication treatment. A parent or guardian must attend any appointment where changes in your child/adolescent’s medication may occur.

We look forward to meeting with you!

The Child, Adolescent and Family Team (Reception: 650-299-4777)